Conservative treatments for De Quervain's tenosynovitis: A systematic review and network meta-analysis

De Quervain's tenosynovitis (DQT) is a common tendinopathy of the first dorsal compartment, managed conservatively or surgically. Among conservative options, the comparative effectiveness remains unclear.

To evaluate the effectiveness of conservative treatments for DQT.

Systematic review and network meta-analysis (NMA).

Following PRISMA and a PROSPERO registration (CRD42023494486), seven databases were searched for randomized controlled trials (RCTs) and non-RCTs. Twenty-one studies (1,178 adults) were included in the qualitative synthesis; 12 entered the NMA. Pain was measured with the visual analog scale or Numerical Pain Rating Scale; function with the Disabilities of the Arm, Shoulder, and Hand questionnaire, the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, or the Duruöz Hand Index. Data were analyzed with frequentist multivariate and univariate NMAs. Interventions were ranked using p scores and the Surface Under the Cumulative Ranking curve. Risk of bias and certainty of evidence were assessed with the Cochrane Risk of Bias 2.0 tool, Risk of Bias in Non-randomized Studies of Interventions, and Grading of Recommendations Assessment, Development, and Evaluation criteria.

Full-time orthosis use plus corticosteroid injection ranked highest for pain and functional improvement, followed by corticosteroid injection alone and acupuncture. All active treatments outperformed waitlist controls. Pain outcomes showed high heterogeneity (I² = 83.5%), whereas functional outcomes were more consistent. No major inconsistencies were detected between direct and indirect estimates. Most studies had high risk of bias; certainty of evidence ranged from low to very low.

Full-time orthosis use g with corticosteroid injection appears the most effective conservative treatment for DQT, though based on low-certainty evidence. Where combined therapy is inaccessible, monotherapies such as orthosis or corticosteroid injection may still provide meaningful benefits. Future high-quality trials should investigate active interventions (e.g., progressive tendon loading and patient education) to address DQT's functional demands beyond passive symptom relief.